Q: I was diagnosed to have Chronic Lymphocytic Leukaemia five years back. I had 4 cycles of chemotherapy with cyclophosphomide and vincristine. After that I am taking Leukeran 10 mg/day for 5 days in a month for the last 4 years. The total count taken monthly varies from 20000-40000. Lymphocytes 75-85%, Haemoglobin 12-14, platelets 125000-16000. No significant lymph node, spleen or liver swelling is seen. My question is do I continue with Leukeran and if so how long?Will I have to change over to the costlier Fludarabine or rituximab therapies and if so at what stage to get longer remissions and survival possibilities? Are these therapies available in India?

A:Chronic lymphatic leukaemia is a slow and chronic disorder. Patients can survive for over 10-15 years with this disease. Cure is not possible but long term control is possible. We normally give treatment for about six months and then stop treatment and wait for symptoms to return. When the symptoms return we restart the treatment. Like this, Leukeran is usually used intermittently. However you have been taking it regularly and your disease is under good control. When the disease stops responding to Leukeran, then we use fludarabine and or rituxan. Both the drugs are freely available in India.